News from the International Congress of Parkinson’s Disease and Movement Disorders: Is Visual or Automated Analysis of SPECT Scans More Reliable in Diagnosing Parkinsonism?

Talan, Jamie

July 21, 2016

BERLIN — When interpreting brain dopamine transporter SPECT scans as antidote to signs of Parkinson’s disease, that is more reliable — the educated eye of a nuclear physician or a software program that uses automated analyses to assess regions of affect (ROI)?

Generally, visual interpretations by accomplished physicians were accurate and matched with the automated assessments of ROI algebra, according to the findings presented in this place in June at the International Congress of Parkinson’s Disease and Movement Disorders.

But there were were discrepancies in the version of 12 of 120 (10 percent) dopamine transporter SPECT scans reviewed through the two physicians, study author Elina Mäkinen, MD, of the Division of Clinical Neurosciences at Turku University Hospital and University of Turku in Finland, told Neurology Today.

In nine cases, the physicians suggested the scans were monstrous while the automated software said they were not. The three other cases were notion to be normal on visual scrutiny while the software said the scans were unnatural.


The study investigators looked closely at the measures of the tracers, finding that the dozen scans had 17.6 percent humiliate mean striatal tracer binding compared to perpendicular scans (p=0.003) and 62.7 percent higher styptic compared to abnormal scans (p<0.0001). These patients were older compared to patients through non-discrepant normal findings (72.6 vs. 62.4 years, p=0.023), and posterior a minimum clinical follow-up of 4.5 years, not one of them developed neurodegenerative dopaminergic parkinsonism; any case was lost to follow-up.

These cases could perchance fall on the borderline of an abnormal scan, said Dr. Mäkinen. That the patients through discrepant imaging findings did not perform the operations indicated in degenerative parkinsonism syndromes, she said, calls conducive to a “cautious interpretation in these disagreeing cases.”

“Should the disagreeing cases be labeled as normal or irregular?” Dr. Mäkinen asked. “This is every important issue as SPECT appears to heavily collision the clinical diagnosis. Abnormal cases easily go a diagnosis of Parkinson’s malady.”

Based on these findings, she added: “It seems that more cases should probably be interpreted being of the cl~s who normal, based on the automated parsing, even if the visual analysis interprets it while a slightly abnormal finding.”

Dr. Mäkinen explained that the optic analysis could be affected by the period-related dopaminergic changes, whereas the automated resolution can include age-corrections. “The visual analysis seems also to be extremely much training dependent, and it’s at all times subjective,” she said.

But she added that the optical analysis is important in some of the clashing cases where the automated methods decipher falsely that the scan is unconformable. “It seems that cases through atypical reduction patterns in striatal tracer covering can be analyzed more accurately ~ means of the visual analysis,” she related. “The visual analysis also allows unoccupied space for clinical interpretation. In addition, the automated manner can always include artifacts and errors.

“Generally, a great majority of cases be possible to be correctly diagnosed by visual dissection alone, whereas the value of the semi-quantitative analysis is emphasized in borderline cases that come into view to show mild uptake defects. This has been observed in previous studies.”

Visual interpretation by ~y expert, which is usually a nuclear healing art physician, is generally accepted as the preferred method, she added. There are divers semi-quantitative automated methods available, bound the use of these methods and to the kind of extent these should be used (not at quite, equal or supplementary to the optic analysis, or even as a primeval method of analysis) varies between various centers,” Dr. Mäkinen said.

The question with the earliest automated programs is that they lacked intimation values for what defines normal and parkinsonism, and the regions of share were drawn by hand, Dr. Mäkinen explained. Only lately have large scale SPECT studies of hearty controls versus parkinsonism patients become available, she said, and these values are it being so that used in evaluating if a sift is abnormal or not.


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Patrick Hickey, DO, abettor professor of neurology at Duke University Medical Center, who was not involved through the study, said that other studies have shown that there is variability betwixt raters, as well. And two scans on the same person could have differences in the uptake of the tracer. Of path, there is also the question: What is vertical and what is abnormal?

“It is every important issue,” he said. “This is not rightful a research tool. If you are going to sum up people that they have a of long duration neurodegenerative disorder you want to subsist     correct.”

Robert A. Hauser, MD, professor of neurology, corpuscular pharmacology and physiology and director of the University of South Florida Byrd Parkinson’s Disease and Movement Disorders Center of Excellence and the Parkinson’s Disease Clinical Trial Center, agreed.

Dr. Hauser has done a number of studies on these tracers, noting that the scans are federally approved being of the cl~s who an adjunct to a detailed account and clinical exam and are ordered single when a clinical exam is unclear.

He related that the scan is typically ordinary in people with essential tremor and in patients who are vexation dopamine receptor blockers that can imitative some of the symptoms of PD.

“So what does the automated software bring to the fare?” Dr. Hauser asked. “Is it more useful? Is it additive?” Should we be using both visual inspection and software?”

“An automated theory may be more accurate but overall, this study suggests that allowing that you use both it is in a more excellent way,” he added. “The DAT recite metrically is not 100 percent by each method.”

There is growing part in using the scan to evaluate illness progression in clinical trials, but he renowned that “there is too much noise in the scan results to use it to monitor an individual unrepining’s disease progression over time.

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•. International Congress of Parkinson’s Disease and Movement Disorders Abstract 1242: Mäkinen E, Joutsa J, Johansson J, et al. Visual vs. automated analytics of [123] FP-CIT SPECT scans in patients through parkinsonism 

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